低频电刺激配合康复训练治疗脑卒中后吞咽功能障碍的临床观察

Clinical effects of low frequency ultrasound neuromuscular electrical stimulation with rehabilitative treatment on dysphagia in the patients with acute stroke

目的探讨运用低频神经肌肉电刺激配合吞咽康复功能训练对脑卒中患者吞咽功能障碍的影响。方法选择2013年1月—2014年2月收治的60例脑卒中吞咽功能障碍患者作为研究对象,随机分为对照组和观察组各30例。对照组给予吞咽功能训练,观察组在对照组的基础上联合低频神经肌肉电刺激治疗。观察两组临床疗效并分别于治疗前与康复治疗后第15、30天进行吞咽造影检查(video fluoroscopic swallowing study,VFSS),比较VFSS评分变化情况。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组治疗后15、30 d VFSS评分分别为(8.49±0.31)、(9.12±0.05)分,均高于对照组的(5.05±0.12)、(5.38±0.13)分,差异均有统计学意义(均P<0.05)。观察组总有效率为96.67%,高于对照组的63.33%,差异有统计学意义(P<0.05)。结论低频神经肌肉电刺激能有效刺激外周神经,引起肌肉节律收缩,有助于肌纤维的代偿性增生,促进神经兴奋和传导功能的恢复,对脑卒中吞咽功能障碍的恢复具有积极的临床价值,值得进一步推广与运用。

Objective To investigate the effect of low frequency ultrasound neuromuscular electrical stimulation along with the swallowing rehabilitative training treatment on dysphagia in the patients with acute stroke.Methods 60 cases of the stroke patients with dysphagia from January 2013 to February 2014 were selected,randomly divided into control group and observation group（n=30）.Patients in the control group were treated with swallowing rehabilitative training.Patients in the observation group were treated with low frequency ultrasound neuromuscular electrical stimulation on the basis of control group.The clinical effect of the two groups and video fluoroscopic swallowing study（VFSS） scores before and after the treatment in 15 and 30 days were record and compared.Measurement data was processed by t test,count data by chi square test,P〈0.05 was considered statistically significant.Results The VFSS scores of observation group after therapy for 15 and 30 days were（8.49 ±0.31）、（9.12 ±0.05）points,higher than that of the control group[（5.05±0.12）、（5.38±0.13）points],differences were statically significant（all P〈0.05）.The total effective rate of the observation group was 96.67%,higher than the control group’s 63.33%,difference was statically significant（P〈0.05）.Conclusion Low frequency ultrasound neuromuscular electrical stimulation can stimulate the peripheral nerves effectively,also can cause muscle contract rhythmically,improves compensatory hyperplasia of the muscle fiber,helps nervous excitement and conduction recover.Has positive effects on the recovery of dysphagia in the patients with acute stroke and is worth to clinical promotion and utilization.